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Be The Light Decor | RFP 26-04-01 — Citywide Holiday Lighting & Decorating Services <br />Page 48 of 55 <br />Dispute Disclosure Form <br />Answer the following questions by placing an "X" after "Yes" or "No". If you answer "Yes", please explain <br />in the space provided, or on a separate sheet attached to this form. <br /> <br />19.1. Has your firm or any of its officers received a reprimand of any nature or been suspended by the <br />Department of Professional Regulations or any other regulatory agency or professional associations <br />within the last five (5) years? <br />YES _____ NO _X_ <br /> <br />19.2. Has your firm, or any member of your firm, been declared in default, terminated, or removed <br />from a contract or job related to the services your firm provides in the regular course of business within <br />the last five (5) years? <br />YES _____ NO _X_ <br /> <br />19.3. Has your firm had filed against it any requests for equitable adjustment, contract claims, Bid <br />protests, or litigation in the past five (5) years that is related to the services your firm provides in the <br />regular course of business? <br />YES _____ NO _X_ <br /> <br />If yes, state the nature of the request for equitable adjustment, contract claim, litigation, or protest, and <br />state a brief description of the case, the outcome or status of the suit, and the monetary amounts or <br />extended contract time involved: <br /> <br />[INSERT DETAILS OR "NONE — NOT APPLICABLE"] <br /> <br />I hereby certify that all statements made are true and agree and understand that any misstatement or <br />misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration <br />of this Bid for the City of Sunny Isles Beach. <br /> <br />Firm: Be The Light Decor <br /> <br />____________________________________________ Authorized Signature <br /> <br />Print Name & Title: Hunter Estess, Founder <br />Date: ___________________________ <br />